1. Field of the Invention
This invention relates to surgical devices and a method for using the same in endoscopic surgery (also known as closed surgery) wherein the surgeon gains access to the surgical site via one or more portals. More particularly, the invention relates to devices and a method for retracting internal organs and distending the walls of a body cavity so that structures can be seen in an adequate panoramic endoscopic view.
2 Description of the Prior Art
U.S. Pat. No. 2,202,748, (Solo) discloses a septum splint for molding the nasal septumi straight following the operation of sub-mucous resection or in traumatic conditions wherein it is desirable to bring into contact or approximation the layers of the nasal septum. The splint comprises a pair of body members, oppositely arranged screws engaging holes in the two body members for adjusting them towards and away from each other, a stationary blade extending from the outer side of each member, blades pivoted to each member, a cam carried by each member and engaging parts of the pivoted blades for moving them outwardly into a fan shape, and a screw engaging a threaded hole in each member for moving the cam against the parts of the blades.
U.S. Pat. No. 4,608,965, (Anspach, Jr., et al.) discloses an endoscope retainer and tissue retracting device comprising a soft plastic cylindrical tube slidably mountable on the probe portion of the endoscope, the end of the soft plastic cylindrical tube having a slightly reduced diameter to have a friction holding fit over the end of the endoscope, a plurality of slits located around the soft plastic cylindrical tube adjacent the end of reduced diameter, said slits forming a plurality of flexible strips which bend to extend radially outwardly when their ends are brought together by sliding the other end of the soft plastic cylindrical tube along on the probe portion of the endoscope toward the end having the friction holding fit over the end of the endoscope, and means for fixing the other end of the soft plastic cylindrical tube to the endoscope with the strips extending radially outward.
U.S. Pat. No. 4,654,028, (Suma) discloses an incision opening expansion holder for inosculation comprising a cylindrical hollow elongated outer tube having a longitudinal axis; a cylindrical elongated inner tube having a longitudinal axis and a first end and a second end and being of a diameter smaller than the diameter of said outer tube and slidably inserted into said outer tube; a grip device fixed to the first end of said inner tube; and a plurality of resilient wires, each having one end thereof attached to the second end of the inner tube and another end thereof having a round ball structure attached thereto, the plurality of wires being shaped to extend radially outward from the axis in a smooth curve. The inner tube is of sufficient length to extend said second end to an end of the outer tube in an opened position and to retract the attached wires to be completely within the outer tube in a closed position. The wires are of sufficient resilience and axial length so as to be compressed into and fit completely within the outer tube in the closed position, and to extend completely outside of said outer tube in the opened position with the round ball structures located at the ends of the wires being spread out radially and with the wires being resiliently expanded to a circular shape.
U.S. Pat. No. 3,823,709, (McGuire) discloses a table supported surgical retractor and pelvic support which comprises an operating table supported surgical retractor assembly for individual retracting blades which hold the various parts of the body away from the surgical area.
U.S. Pat. No. 3,858,578, (Milo) discloses a surgical retaining device comprising a retaining arm, the rigidity of which is controlled by a fluid actuated operating apparatus. A surgical instrument is attached to the retaining arm. By activating the operating apparatus, the arm can be made flexible as the instrument is being positioned and rigid once the instrument is in place.
U.S. Pat. No. 4,099,521, (Nestor, et al.) discloses a surgical retractor adjustable mounting apparatus comprising an arcuate frame sized to fit concentrically at a spaced distance about the head. Retractors, retaining the mouth and lips in open position for vertical and lateral exposure during mouth and jaw surgery, are adjustably suspended from the frame by an adjustable universal connector. The frame is mounted on an upstanding support from the operating table by connecting means providing adjustability thereof for universal spatial orientation.
U.S. Pat. No. 4,457,300, (Budde) discloses a surgical retractor provided for retaining tissue, membrane and organs in a retraced position from an incision during a surgical procedure which includes a tiltable ring having an outwardly extending channel to receive arm support means having a projection captured within and movable along the channel. Retractor arms are mounted to the arm support means such that they pass below the ring and extend inwardly toward the incision so as to not obstruct the surgeon's line of sight or movement of the hands along the ring.
U.S. Pat. No. 4,573,452, (Greenberg) discloses a surgical holder for a laparoscope or the like wherein a selectively tensionable cable-type component is released for moving the laparoscope almost into its desired position and then tensioned into a rigid structure; and then a ball and socket joint is rendered operational to complete the moving of the laparoscope, if need be, to precisely position the instruments in its required anatomy-viewing position.
U.S. Pat. No. 4,593,681, (Soni) discloses a stabilizing device for use in arthroscopic and endoscopic surgery comprising a relatively thin, flat, flexible plate of plastic material and adapted to be placed against a patient's body at the area where penetration is made by the scope sheath. The plate is formed with a predetermined sized central hole and the sheath is slidably insertable through the hole and has an interference fit with the surrounding plate material. The plate provides a stable base for the scope to be slidable moved with respect to the plate to adjust the depth of penetration.
U.S. Pat. No. 4,621,625, discloses a leg traction device for supporting the leg and applying axial force to the leg wherein a rigid vector bar is positioned above the knee and lower leg and a pulley system including a cable and weight connected at one end to a leg supporting structure and at the other end to the vector bar.
U.S. Pat. No. 4,632,458, (Brown, et al.) discloses a chair back height adjustment mechanism for a chair having a chair back supporting standard and a chair back bracket with a chair back or backrest mounted thereon. The mechanism includes a rack gear on the chair back standard, a pinion gear supported in a bearing on the chair back bracket, a worm gear coaxial with the pinion gear, and worm threads on a dial shaft supported on the bracket. Rotation of the dial causes the worm member to rotate the worm gear and the pinion gear whereby the bracket supporting the pinion gear is translated in relation to the chair back standard.
U.S. Pat. No. 4,690,647, (Dalglish) discloses an intravenous tube assembly to supply intravenous fluid to a patient. The assembly comprises an intravenous fluid container, held by a stand, and connected to one end of an intravenous fluid tubing, the other end of the tubing connected to a patient, and a mast assembly which has an elongate resilient mast and a movable tip and a base. The base is fixed to a structure proximate the patient, e.g., a bed frame; and the tip carries a tube holder which releasably holds a segment of the intravenous tubing leading to the patient. The mast permits patient movement by deflecting to follow the patient and rebounding upon return of the patient to prevent an excess of residual intravenous tube in the vicinity of the patient.
U.S. Pat. No. 4,809,687, (Allen) discloses a medical stirrup for supporting a patient's limb in a desired attitude is disclosed. The limb is cradled in a shell lined with soft material. The limb is retained in the shell by adjustable bands. The shell is suspended from a support by adjustable straps; and the attitude of the limb is controlled by the adjustment of the straps and the positioning of the support.
U.S. Pat. No. 4,850,563, (Grout) discloses an adjustable desk frame comprising a base consisting of a pair of vertically extending transversely spaced members; a sub-frame vertically movably adjustably supported by the base, and including a pair of vertically extending members telescopically received within the vertical members of the base; and a drive assembly to move the sub-frame vertically relative to the base, the drive assembly including a rack gear attached to each vertical member of the sub-frame, a pinion gear meshingly engaged with each rack, with the pinion gears being rotatably supported by the base, a shaft extending between the two pinions to transmit rotary power therebetween, a worm gear meshingly engaged with one of the pinions, and rotatably supported by the base, and a drive shaft fixed to the worm gear and extending therefrom to a position manually operably by a user of the desk, the drive shaft adapted to be supported by the sub-frame.
U.S. Pat. No. 4,867,404, (Harrington, et al.) discloses a flexible holder for a cytoscope or the like which is equipped with a clamping assembly which permits the holding of various sized instrument shafts. The clamping assembly comprises a vertically adjustable spring-biased C-shaped open-sided region, which is telescopically movable in a tubular housing and releasably urged to an open position. The instrument shaft is received sideways into the C-shaped jaw and retained between the jaw and a pair of circumferentially opposing notches of the tubular housing.
U.S. Pat. No. 4,926,849, (Downey) discloses an apparatus for separating vertebrae, i.e. adjacent first and second vertebrae, during surgery comprising: a support; first and second grips associated with the support and being sized and structured to grip the first and second vertebrae, respectively; a first movement assembly, associated with the first grip, capable of moving the first grip to a desired location relative to the second grip; and a second movement assembly, associated with the second grip, capable of moving the second grip to a desired location relative to the first grip.
U.S. Pat. No. 4,932,395, (Mehdizadeh) discloses a hemi-laminectomy retractor attachment device, adapted for use with prior art retractors, including two hook-shaped members that are joined together by a length of strong flexible cord. The hook-shaped members are narrow enough to fit between spinal bones to brace against the spinal ligaments, and the cord is engagable with the retractor arm.
U.S. Pat. No. 4,945,896, (Gade) discloses a surgical retractor having a generally flat malleable blade with a miniature metabolic parameter sensor embedded or removably inset into the blade to monitor tissue viability of the tissue underlying the retractor.
U.S. Pat. No. 5,003,967, discloses a traction support member for holding an individual's arm and hand in elevated position. The traction support member includes an upright member which is disposed between first and second transverse members. The upright member is movable about a vertical axis universal positioner; and the first transverse member is movable about a horizontal axis through an attachment coupling at which the first transverse member is attached to the upright member.
U.S. Pat. No. 5,065,739, (Forrest, et al.) discloses a retractor support assembly comprising a rocking arm, means for flexibly connecting the retractor to the rocking arm and weight means, connected to the rocking arm, for pulling the retractor in a generally upward direction.
As may be readily ascertained, few of the aforementioned devices refer to endoscopic surgery. By endoscopic surgery is understood surgery during which the surgeon gains access to the surgical site via one or more portals. Through these portals, endoscopes, instruments and the like are inserted. The endoscopic surgical procedures include, but are not limited to, arthroscopy, laryngobronchoscopy, laparoscopy (pelviscopy), gastroenteroscopy, and laparoscopic surgery of the female reproductive organs.
Endoscopic surgery would be preferred over open surgery for most procedures because it greatly reduces trauma and risk of general anesthesia-related complications to the patient and saves the costs associated with performing the surgical procedures. However, the below outlined disadvantages had not allowed full expansion in the areas in which this type of surgery could be competently performed.
To date, it is necessary to infuse the body cavity with CO.sub.2 or N.sub.2 O in order to achieve sufficient expansion of the cavity in order to obtain proper panoramic viewing. A major drawback of the present technique, as explained in the example of laparoscopy, is the necessity to maintain an air-tight boundary between the inside and outside of the body cavity, i.e., the abdomen, in order to obtain proper visualization of structures. Another important handicap is the fact that in spite of the floating effect created by the gas, it is still not possible to reach deep-seated areas. Other disadvantages include image distortion and patient discomfort.